Individual
MARION GOMEYAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2130 ANDERSON MILL RD, AUSTELL, GA 30106-1806
(770) 941-8813
Mailing address
2130 ANDERSON MILL RD, AUSTELL, GA 30106-1806
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4581
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056162053
DRIVERS LICENSE
GA
01
—
4581
PROFESSIONAL LICENSE
GA
Enumeration date
09/20/2018
Last updated
06/11/2019
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